Kids With Asthma Play Hard, Too

In a Shift in Advice, Doctors Tell Patients to Get as Much Exercise as Their Peers

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Celia Vigil keeps inhalers stashed around her family's house, car and wherever else she may need to find one.
Rajah Bose for The Wall Street Journal

By

Shirley S. Wang

April 22, 2013 6:58 p.m. ET

Children with asthma should play hard in gym class and stop worrying they might have an attack that could leave them struggling to breathe, respiratory specialists are now recommending.

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Celia Vigil, above center, who has asthma, plays soccer with her dad, Joe, and sister Elisa outside their home in Spokane, Wash.
Rajah Bose for The Wall Street Journal

Physical activity by people with asthma isn't harmful and might even be helpful to treating the condition, doctors in the field believe. A report published last year in the Cochrane Database Systems Review, a journal that reviews health-care treatments and decision making, looked at 19 previous studies of exercise and asthma and concluded that people with the respiratory condition fared well with physical activity. The studies' results ranged from showing no difference in patients' asthma control to an increase in the number of symptom-free days and a decrease in asthma severity.

For kids with asthma, more doctors are prescribing the once unthinkable: exercise. WSJ "In the Lab" columnist Shirley Wang unpacks the latest research on Lunch Break. Photo: Getty Images.

Laboratory studies on animals with asthma also have shown that exercise appears to reduce the severity and frequency of attacks, says
Timothy Craig,
an immunologist and allergist at Pennsylvania State University College of Medicine in Hershey, Pa. The experiments with mice found that exercise calms the activity of inflammatory proteins and peptides in airways that, when stimulated, cause an attack, he says.

"If you have good, controlled asthma, you should be able to exercise," Dr. Craig says.

Fear of physical activity is real for many asthma patients. Exercise can spur an attack, in which the airways get inflamed and lung muscles contract, making it hard for people to catch their breath. If untreated, serious cases can lead to death.

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Celia Vigil in her taekwondo dobok.
Rajah Bose for The Wall Street Journal

Asthma affects about 9% of children in the U.S. under the age of 17, and for many the condition is lifelong. Overall, more than 25 million Americans of all ages have asthma, representing about 8.4% of the population in 2010, up from 7.3% in 2001, according to data from the Centers for Disease Control and Prevention.

With nearly 1 out of 10 children having asthma, it is important to find ways for them to engage in physical activity, health officials say. Being sedentary increases the risk of obesity. Kids with asthma may struggle socially as well. Being sidelined from gym class or other group activities may make them feel isolated, and other children may see them as fragile and a target for teasing.

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When exercise leads to frequent asthma attacks, it is a sign the asthma isn't well controlled and that a better treatment plan is needed, Dr. Craig says. In most of these cases, both the physicians and patients have underestimated the asthma, he says. Patients may then become frustrated and anxious and abandon efforts to exercise, he says.

Celia Vigil, a 12-year-old in Spokane, Wash., avoided strenuous exercise for years for fear of an asthma attack. When she did participate in school sports, she says she usually didn't get very far and often had to be pulled quickly out of a game. An asthma flare-up left her feeling like she couldn't get enough air. "It feels scary," she says. "You don't know when you'll get out of it."

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The Vigils, from left, Elisa, Celia, Cynthia and Elena, on a family hike near their home in Spokane, Wash., last summer.
Joseph Vigil

Working Out Safely

Specialists say exercise is important for people with asthma and can even help improve respiratory function. Here are some tips for exercising safely with asthma:

Make an asthma plan: With a doctor, get your asthma under control. Some people may need to use an inhaler before exercising.

Warm up: Gradually increasing your heart rate is less likely to trigger an attack than increasing it quickly.

Sustain activity: Once warmed up, heart rate should remain up for about 30 minutes. For most people, this means a heart rate of 120 to 180 beats per minute depending on your age.

Sustain activity: Once warmed up, heart rate should remain up for about 30 minutes. For most people, this means a heart rate of 120 to 180 beats per minute depending on your age.

For people with asthma and allergies, it is best to exercise indoors on highpollen, mold-spore or pollution days.

Source: Timothy Craig, Pennsylvania State University

Two years ago, Celia started seeing a new doctor who talks about the importance of exercise at each visit. She switched to a longer-acting medication, Advair, that better controls her symptoms. And she sometimes takes two puffs on her inhaler before exercising, which she wasn't doing before. Now, Celia says, she is able mostly to keep up with the other kids in gym class. "It's more fun to participate," she says. "I've come really far."

Even when people with asthma have a good treatment plan in place, they need to take extra precautions while exercising, Dr. Craig says. Patients should warm up before walking or jogging, for example, by starting at a slower pace. They also should "warm down" afterward by reducing speed or exertion before stopping completely. Changing one's heart rate gradually appears to lower the risk of an attack, Dr. Craig says.

Children and adolescents with asthma that is under control should aim to achieve the same level of exercise recommended by the CDC as young people without the condition, Dr. Craig says. These recommendations include at least 60 minutes of moderate-intensity aerobic exercise a day, such as brisk walking, plus high intensity activity three times a week.

Guidelines from the National Asthma Education and Prevention Program, issued by the federal National Heart, Lung and Blood Institute, calls for doctors to encourage asthma patients to actively participate in sports and other physical activities.

Still, many parents, sports coaches and doctors who aren't respiratory specialists either don't know that exercise can be helpful for kids with asthma, or they don't routinely talk about exercise with their patients. "I feel there's a lot of education that still needs to take place" in the medical community, says
Michele Shaw,
a professor at Washington State University College of Nursing who studies exercise in children, with a focus on those with asthma.

Asthma attacks can be brought on by exercise, cold and other triggers, says
Shawna Strickland,
a respiratory therapist and an associate executive director of the American Association for Respiratory Care. Treatment often includes inhaled corticosteroids, to reduce inflammation, and long- and short-acting beta agonists like albuterol, to relax airway muscles. For some patients, taking a puff or two from an inhaler before exercise can ward off an attack.

Cynthia Vigil, Celia's mother, says the family gradually limited the girl's physical activity when she was younger because of repeated severe asthma attacks. Celia wasn't allowed to go sledding because cold air made her asthma worse; she couldn't play outside with other kids or her two younger sisters, who don't have asthma. "Every one of the messages came out of fear from us," says Ms. Vigil, who works as a counselor at a community college.

It was at a hospital after a severe attack that an emergency room doctor two years ago talked with them about the need to get Celia's asthma under better control. The Vigils followed the doctor's medication advice. They also switched pediatricians.

Ms. Vigil says Celia hasn't had an asthma attack since she's become more active. Last winter, she went snow shoeing with classmates for the first time and she completed a 7-mile walk-run with her family last May. She has also lost weight.

Teachers still call home to ask if it is OK for Celia to participate in certain activities, Ms. Vigil says. She says she still has residual fears about Celia exercising, but she is trying to be encouraging of the girl's interest in joining a sports team in middle school. Celia, who says she feels more included at school, says she is excited to try volleyball this summer to see if it will be her sport.

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